Abstract
Phobic postural vertigo (PPV) (Brandt and Dieterich 1986; Brandt 1996) has been described as a syndrome that is distinguishable from panic disorder, agoraphobia, and the pseudo-agoraphobia syndrome “space phobia” (Marks 1981). Since we began diagnosing it as a clinical entity, PPV has become the second-most common cause of vertigo in our dizziness unit (p. 23). Closely connected with gait and posture, PPV is characterised by a combination of non-rotational vertigo with subjective postural imbalance and unsteadiness, normal neuro-otological tests, and phobic avoidance behaviour mainly in patients with an obsessive-compulsive personality. The monosymptomatic subjective disturbance of balance manifests with superimposed attacks that occur with and without recognisable provoking factors in one and the same patient. The patient experiences them with and without accompanying excess anxiety, misleading both patient and physician to make a false diagnosis of organic disease. Although an association of PPV with anxiety disorders is evident, not all patients present with symptoms of anxiety or panic during attacks of vertigo. However, most patients develop a disabling “phobic/avoidance pattern” (Kapfhammer et al. 1997). These patients contact neurologists or otolaryngologists first and foremost and not psychiatrists or psychotherapists, since their prevailing complaint is distressing postural imbalance and vertigo.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Agras WS, Chapin HN, Oliveau DC (1972) The natural history of phobia. Arch Gen Psychiatry 26: 315–317
Ballenger JC, Burrows GD, Du Pont RL (1988) Alprazolam in panic disorder and agoraphobia: results from a multicentre trial. Arch Gen Psychiatry 45: 413–422
Barlow DH (1990) Long-term outcome for patients with panic disorder treated with cognitive-behavioral therapy. J Clin Psychiatry 51 (Suppl A): 17–23
Beitman BD, Basha I, Flaker G, De Rosear L, Mukerji V, Lamberti J (1987) Non-fearful panic disorder: panic attacks without fear. Behav Res Ther 25: 487–492
Brandt Th (1996) Phobic postural vertigo. Neurology 49: 1480–1481
Brandt Th, Daroff RB (1980) The multisensory physiological and pathological vertigo syndromes. Ann Neurol 7: 195–203
Brandt Th, Dieterich M (1986) Phobischer AttackenSchwankschwindel. Ein neues Syndrom. Munch med Wochenschr 128: 247–250
Brandt T, Huppert D, Dieterich M (1994) Phobic postural vertigo: a first follow-up. J Neurol 241: 191–195
Brandt T, Kapfhammer HP, Dieterich M (1997) Phobischer Schwankenschwindel. Eine weitere Differenzierung psychogener Schwindelzustände erscheint erforderlich. Nervenarzt 68: 848–849
Bronstein AM (1995) Visual vertigo syndrome: clinical and posturography findings. J Neurol Neurosurg Psychiatry 59: 472–476
Bronstein AM, Gresty MA, Luxon LM, Ron MA, Rudge P, Yardley L (1997) Phobic postural vertigo. Neurology 49: 1480–1481
Brown JJ, Baloh RW (1987) Persistent mal de debarquement syndrome: a motion-induced subjective disorder of balance. J Otolaryngol 8: 219–223.
Crowe RR (1990) Panic disorder: genetic considerations. J Psychiatr Res 24: 129–134
Eckhardt-Henn A, Hoffman SO, Tettenborn B, Thamlske C, Hopf HC (1997) Phobischer Schwindel. Nervenarzt 68: 806–812
Ford CV, Folks DGC (1985) Conversion disorders: an overview. Psychosomat 26: 371–382
Frommberger U, Angenendt J, Berger M (1995) Die Behandlung von Panikstörungen und Agoraphobien. Nervenarzt 66: 173–186
Furman JM, Jacob RG (1997) Psychiatric dizziness. Neurology 48: 1161–1166
Fyer AJ, Mannuzza S, Gallops MS, Martin LY, Aaronson C, Gorman JM, Liebowitz MR, Klein DF (1990) Familial transmission of simple phobias and fears. Arch Gen Psychiatry 47: 252–256
Gordon CR, Spitzer O, Doweck I, Melamed Y, Shupak A (1995) Clinical features of Mal de debarquement: Adaption and habituation to sea conditions. J Vestib Res 5: 363–369
Gresty MA, Bronstein AM, Brandt Th, Dieterich M (1992) Neurology of otolith function: Peripheral and central disorders. Brain 155: 647–673
Holst E v, Mittelstaedt H (1950) Das Reafferenzprinzip ( Wechselwirkung zwischen Zentralnervensystem und Peripherie ). Naturwissenschaften 37: 464–476
Huppert D, Brandt T, Dieterich M, Strupp M (1994) Phobischer Schwankschwindel. Nervenarzt 65: 421–423
Huppert D, Kunihiro T, Brandt T (1995) Phobic postural vertigo (154 patients): its association with vestibular disorders. J Audiol Med 4: 97–103
Kapfhammer HP, Mayer C, Hock U, Huppert D, Dieterich M, Brandt T (1997) Course of illness in phobic postural vertigo. Acta Neurol Scand 95: 23–28
Krafczyk S, Schlamp V, Dieterich M, Haberhauer P, Brandt Th (1998) Increased body sway at 3.5–8 Hz in patients with phobic postural vertigo. Neurosci Lett 259: 149–152
Lazare A (1981) Current concepts in psychiatry. Conversion symptoms. N Engl J Med 305: 745–748
Lesser IM, Rubin RT, Pecknold JC, Rifkin A, Sinson RP, Lydiard RB, Burrows GD, Noyes R, Du Pont RL (1988) Secondary depression in panic disorder and agoraphobia. I. Frequency, severity, and response to treatment. Arch Gen Psychiatry 45: 437–443
Lilienfeld SO, Jacob RG, Furman JMR (1988) Vestibular dysfunction followed by panic disorder with agoraphobia. J Nery Ment Dis 177: 700–701
Mair IWS (1996) The mal de débarquement syndrome. J Audio] Med 5: 21–25
Marks IM (1981) Space “phobia”: a pseudo-agoraphobic syndrome. J Neurol Neurosurg Psychiatry 44: 387–391
Murphy T (1993) Mal de debarquement syndrome: a forgotten entity? Otolaryngol Head Neck Surg 109: 10–13
Noyes R, Clancey J, Hoenk PR, Hymen DJ (1980) The prognosis of anxiety neurosis. Arch Gen Psychiatry 37: 42–50
Noyes R, Holt CS (1994) Anxiety disorders. In: Winokur G, Clayton PJ (eds) The medical basis of psychiatry, 2nd edn. Saunders, Philadelphia
Page MGR, Gresty MA (1985) Motorist’s vestibular disorientation syndrome. J Neurol Neurosurg Psychiatry 84: 729–735
Pratt RTC, McKenzie W (1958) Anxiety states following vestibular disorders. Lancet II: 347–349
Stahl SM, Soefje S (1995) Panic attacks and panic disorder: The great neurologic impostors. Semin Neurol 15: 126–132
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2003 Springer-Verlag London
About this chapter
Cite this chapter
Brandt, T. (2003). Phobic postural vertigo. In: Vertigo. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-3801-8_32
Download citation
DOI: https://doi.org/10.1007/978-1-4757-3801-8_32
Publisher Name: Springer, New York, NY
Print ISBN: 978-0-387-40500-1
Online ISBN: 978-1-4757-3801-8
eBook Packages: Springer Book Archive